Healthcare Provider Details

I. General information

NPI: 1477514867
Provider Name (Legal Business Name): PORTER HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GLENDALE BLVD
VALPARAISO IN
46383-3767
US

IV. Provider business mailing address

26700 BROOKPARK ROAD EXT SUITE 1
NORTH OLMSTED OH
44070-3124
US

V. Phone/Fax

Practice location:
  • Phone: 216-464-0232
  • Fax: 219-759-3807
Mailing address:
  • Phone: 800-611-6912
  • Fax: 440-716-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL HAMMOND
Title or Position: CFO
Credential:
Phone: 219-364-3660